OB-GYN Billing Mistakes That Trigger Audits — and Quietly Cost Practices $8K–$25K Per Quarter

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  The Part No One Warns You About Your OB-GYN claims are getting paid. Your revenue looks stable. Your billing team says things are “fine.” That doesn’t mean your practice is safe. Most OB-GYN audits don’t start with denials, warnings, or red flags you can see. They start silently , months after payers have already paid your claims—when the money has been spent, the charts are archived, and staff turnover has already happened. By the time the recoupment letter arrives, the damage is already done. The Reality Most Practices Learn Too Late Payers don’t audit claims they deny. They audit claims they’ve already paid . For OB-GYN practices, audits typically occur 6 to 18 months after payment . That timing is intentional. It gives payers leverage—because now you’re being asked to return money that’s already been allocated to payroll, rent, malpractice premiums, and growth. This isn’t a reflection of bad intent or sloppy practices. It’s how the system is designed. And OB-GYN...
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E/M Coding Basics for Internal Medicine

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Evaluation and management is the most important part of the practice for an internist and coding for these visits can have an important effect on the bottom line of a practice. The decision about what level to bill an evaluation and management code is rarely clear to most physicians. In order to determine what code to select for an evaluation and management procedure, it helps to first learn the elements of a code. Once you understand the elements and how they come together to create the level, it can be a lot easier to select a code with confidence. In this article, we will focus on the documentation standards for evaluation and management codes: 

 
Chief Complaint
 
Every evaluation and management visit should start with a chief complaint - some kind of reason why the patient needs to be seen. Only a simple explanation is needed, it may be “cough” “1-year recheck of diabetes” or “nausea since Tuesday.” The chief complaint is required in order to establish medical necessity, a fundamental element of the Medicare program and a required element for billing this series of codes for the private sector as well. 

If you want to read the complete blog then click below: E/M Coding Basics for Internal Medicine


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